Safeguarding fears over children’s mental health bed shortage

Delays accessing beds have put mentally unwell children at risk, with some attempting to take their own lives while they waited for hospital care, according to children’s psychiatrists.

The Royal College of Psychiatrists surveyed 370 psychiatrists working in child and adolescent mental health services in the UK. Eight out of 10 respondents reported safeguarding concerns while waiting for a bed, with 14% of respondents’ describing cases where patients had attempted suicide while waiting for a bed and 13% describing episodes of violence linked to the delays.

The survey was carried out in December 2013. Since then the government has set up a taskforce to review children’s mental health care. The taskforce is due to report its findings soon.

One respondent to the survey, said: “Finding a bed has become much harder this year and we are needing to keep children longer on paediatric wards. There are no local tier 4 provisions, which means families have long distances to travel. Rates of referrals and suicidal teens seem to be increasing. In our area we have had five completed suicides this year, which is unheard of.”

The College said that doctors reported increasing difficulty accessing beds due to a range of factors. These included a rise in referrals, cuts to community services to support people out of hospital, bed closures and reduced social care provision. The College said ‘urgent action’ was needed to improve care, including an investment in community mental health services and intensive outreach teams.

Key findings

Other key findings from the survey included:

• Over 70% of respondents experienced frequent difficulties securing beds;
• Almost 90% said they had been forced to send children out-of-area for beds. One doctor reported sending a patient more than 500 miles away from home for a bed.
• Most respondents (61.9%) reported young people having been held in inappropriate settings such as paediatric wards, police cells and A&E departments.
• More than three quarters of respondents said that young people with “unacceptably high risk profiles” were having to be managed in the community because of a lack of beds.

Spending cuts

In January it was revealed that spending on children’s mental health services fell by the equivalent of £50m between 2009-10 and 2012-13 in real-terms, a 6% cut. Last year, an investigation by Community Care and BBC News revealed how problems accessing beds for young people in crisis had led to acutely unwell children being admitted to adult mental health units or sent hundreds of miles for care.

Dr Peter Hindley, chair of the Royal College of Psychiatrist’s child and adolescent faculty, said: “It is unacceptable that children and young people are stuck in this gap between community and inpatient care. This survey shows just how devastating the consequences can be.

“We need urgent action to support these individuals and their families.  Ensuring the safety of children and young people should be the number one priority. Failure to improve both inpatient and community care will mean they will continue to be at risk to themselves and others.”

Reaction

Lucie Russell, director of campaigns and media at YoungMinds, said: “This is yet more worrying and distressing news about the state of children and young people’s mental health services. Increasing numbers of young people are experiencing extreme levels of suffering and if they don’t get the help they need then their suffering and that of their families just increases as this survey so graphically illustrates.

“We should not be putting young people who desperately need help on paediatric wards, police cells and leaving them in A&E departments, nor should we be discharging them into the community when their pain is unbearable. We await the results  of the government’s current taskforce on children and young people’s mental health services,  because support for young people’s mental health just cannot continue in this mess.”

Care and support minister Norman Lamb said: “It’s essential that anyone experiencing a mental health crisis gets urgent, compassionate care in the right environment. I’ve been very clear that I want to ban the use of police cells for under-18s who need mental health care and that cells should only be used for adults in exceptional circumstances.

“We’ve taken action to get NHS, police and other services working together to help end the use of police cells. Every area in the country has signed up to our Crisis Care Concordat. Nationally the use of police cells has already dropped by nearly a quarter this year and so far this year for under 18s the use of police cells has fallen by nearly a third. I will continue to push for further progress.”

The Samaritans’ 24-hour helpline is 08457 909090